DEEP CIRCUMFLEX ILIAC ARTERY (DCIA) FLAP

History

O’Brien, 1976 (BJPS) first transferred iliac crest and groin skin using SCIA. Taylor, 1979 (PRS) used DCIA

Anatomy

From external iliac artery, directly opposite DIEA

Artery travels towards the ASIS between the transversalis fascia and the tranversus abdominus muscle.

Gives off an ascending branch medial to ASIS and continues along the inner aspect of the iliac crest between iliac muscle and transversalis fascia.

Anatomical variations

Ascending branch occasionally large and be mistaken for DCIA.

Main trunk of DIA may pierce tranversus to lie superficial to it

DCIA may be duplicated.

Dimensions

8x18cm bone segment

12x6cm skin island

Flap elevation

Inguinal crease incision from femoral pulse to ASIS. Incision through Ext Ob aponeurosis to identify pedicle origin. Round ligament or spermatic cord retracted medially to expose vessels.

Dissection continues laterally – just proximal to ASIS, lat cutaneous nerve of thigh is identified and preserved.

Fibres of internal oblique and transverses muscle divided and DCIA is followed.

Ascending branch identified and divided. Vessel followed laterally as it courses along the inner surface of the ilium until the length of bone for flap is exposed.

For osseous flap: TFL and gluteus medius are dissected free from lateral border of iliac crest – osteotomies then performed, sparing the ASIS; If full thickness of ilium not required, then TFL and G-Med need not be detached

For osseomyocutaneous flap: Skin island designed. 3-4cm above iliac crest, the three muscles are incised, leaving a 2-3cm cuff of muscle with the skin flap attached to the underlying muscle and bone. Below iliac crest, small cuff of TFL and gluteus medius included with skin island and bone

 Donor site closure is in layers and with approximation of muscles superior and inferior to bone, to prevent herniation.

References